Provider Demographics
NPI:1689976896
Name:INGRAM-SANDERS, MICHELLE M (CPM, CDEM)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:INGRAM-SANDERS
Suffix:
Gender:F
Credentials:CPM, CDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-1078
Mailing Address - Country:US
Mailing Address - Phone:812-329-4547
Mailing Address - Fax:888-906-3138
Practice Address - Street 1:1516 H ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3832
Practice Address - Country:US
Practice Address - Phone:812-329-4547
Practice Address - Fax:888-906-3138
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN90000012A176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN90000012AOtherMEDICAL LICENSING BOARD